急性缺血性卒中患者肾功能下降的危险因素——基于医院的回顾性病例系列研究

Risk factors for ischemic stroke A hospital-based reduced kidney function in patients with acute retrospective case series study

目的探讨缺血性卒中患者肾功能下降的危险因素。方法回顾性分析缺血性卒中患者的病历资料，按估计肾小球滤过率（estimated gtomerular filtration rate，eGFR）水平分为肾功能正常组[eGFR≥60ml／（rain·1．73m^2）]和肾功能下降组[eGFR〈60ml／（min·1．73m^2）]。应用多变量logistic归分析确定缺血性卒中患者肾功能下降的危险因素。结果共纳入805例缺血性卒中患者，8．8％的患者存在肾功能下降。肾功能下降组轻度和中度神经功能缺损的患者比例与肾功能正常组无显著差异（P均〉0．05），但重度神经功能缺损的比例显著高于正常组（8．4％对2．6％，X2=5．573，P=0．017）。肾功能下降组小血管闭塞性卒中比例显著高于肾功能正常组（66．2％对46．5％，，=9．962，P=0．002），而大动脉粥样硬化性卒中比例显著低于。肾功能正常组（19．7％对43．5％，，=15．045，P：0．000）。多变量logistic回归分析提示，老年[优势比（oddsratio，OR）3．301，95％可信区间（confidenceinterval，CI）1．575-6．918；P=0．002]是肾功能下降最重要的独立危险因素，其次为女性（OR2．291，95％CI1．355～3．872；P：0．002）和高脂血症（OR2．527，95％CI1．095～5．831；P=0．030）。结论缺血性卒中患者肾功能下降与老年、女性和高脂血症密切相关。

Objective To investigate the risk factors for reduced renal function in patients with ischemic stroke. Methods The medical records of patients with ischemic stroke were analyzed retrospectively. They were divided into normal renal function group and reduced renal function group. Reduced renal function was defined as estimated glomerular filtration rate （eGFR） 〈60 ml/（min-1.73 m2）. Multivariate logistic regression analysis was used to identify the risk factors for reduced renal function in patients with ischemic stroke. Results A total of805 patients with ischemic stroke were enrolled in the study. 8. 8% of patients had a reduced renal function. There was no significant differences in the proportion of patients with mild and moderate neurological deficit between the reduced renal function goup and the normal renal function group （all P〉 0. 05）, however, the proportion of patients with severe neurological deficit was significantly higher than that in the normal renal function group （8.4% vs. 2. 6%, X2 =5. 573, P =0. 017）. The proportion of small artery occlusion in the reduced renal function group was significantly higher than that in the normal renal function group （66. 2% vs. 46. 5%, X^2 =9.962, P = 0. 002）, and the proportion of large artery atherosclerosis was sigrdficantty lower than that in the normal renal function group （19. 7% vs. 43.5%, X^2 = 15. 045, P = 0. 000）. Multivariate logistic regeession analysis indicated that old age （odds ratio [OR] 3.301, 95% confidence interval [CI], 1. 575 to 6. 918; P= 0. 002） was the most important independent risk factor for reduced renal function, then was female （OR, 2. 291, 95% CI 1. 355 to 3. 872; P =0. 002） and hyperlipidemia （OR, 2. 527, 95% CI 1. 095 to 5. 831; P =0. 030）. Conclusions Reduced renal function in patients with ischemic stroke is strongly associated with old age, female, and hyperlipidemia.